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Pediatrics Flashcards

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1
Q

Complications of GAS infection (10)

A
  1. Peritonsillar abcess
  2. Retropharyngeal abcess
  3. Rheumatic fever
  4. PANDAS - acute OCD
  5. Post strep GN
  6. Scarlet fever
  7. Toxic shock syndrome
  8. Otitis Media
  9. Cervical adneitis
  10. Post Strep Arthritis
  11. Meningitis
  12. Bacteremia
  13. Cellulitis (not from strep throat tho)
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1
Q

Complications of GAS infection (10)

A
  1. Peritonsillar abcess
  2. Retropharyngeal abcess
  3. Rheumatic fever
  4. PANDAS - acute OCD
  5. Post strep GN
  6. Scarlet fever
  7. Toxic shock syndrome
  8. Otitis Media
  9. Cervical adneitis
  10. Post Strep Arthritis
  11. Meningitis

Tx: prevents Rheumatic fever and scarlet fever.

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2
Q

Whats the treatment for mastitis?

A

Cloxacillin (staph is resistance to penicillin)

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3
Q

What supplements do breast fed infants need? (4)

A
  1. Vit K (IM at birth)
  2. Vitamin D (400IU/day)
  3. Iron (4-12 months)
  4. Flouride
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4
Q

Whats the difference between BF jaundice and breast milk jaundice?

A
  1. BF jaundice occurs in first 1-2 weeks. Due to lack of milk production and dehydration
  2. Breast milk jaundice due to incr betaglucuronidase in breast milk that inhibits the conjugation of bilirubin (goes back into circulation)
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5
Q

Peds: formula to estimate child’s weight

A

child>1 yr: Agex2 + 8 (kgs)

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6
Q

What is the normal amount of wt gain for newborn?

A

Its normal for them to loss up to 10% of birth wt in first week. then should gain 20-30g/day

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7
Q

Peds: What is maternal PKU?

A

Its a deficiency Phenylalanine hydroxylase. this prevents the conversion of phenylalanine to tyrosine - results in build up of toxic metabolites. Newborns have congenital abN (microcephaly, progressive mental retardation)
- Is screen for in all newborns

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8
Q

What are the 3 cardiovascular shunts in the new born?

A
  1. Foramen ovale (connects R and L atrium)
  2. Ductus arteriosus (connects RV to aorta - bypasses pulmonary a. to lungs)
  3. Ductus venosus (Connects umbilical vein to IVC - bypassing the liver)
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9
Q

What is physiologic jaundice?

In what time frame do you see babies?

A

It is jaundice seen AFTER the first 24 hours (if seen with first 24 h = pathologic jaundice)
- Its is due to a lot of things:
- Breast feeding - dehydration and lack of milk
- Incr Hct and shorter rbc life span (80-90days)
- Impaired hepatic clearance (patent ductus venosus)
- Enzyme def of UPD glucuronyl-transferase (coverts bili to direct bili to be excreted)
-

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10
Q

Peds: In breast milk jaundice - what enzyme is increased? (this is the reason why they are jaundiced

A

There is an increase in beta-glucuronidase (this converts bili diglucuronide to bili which is then recirculated
- UDP glucuronyl transferase - converts bili to direct bili which is then excreted in stool

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11
Q

Peds: What are causes of pathologic jaundice?

A

OVER PRODUCTION
- ABO incompatible or Rh
- Drugs
- rbc d/o (spherocytosis, elliptocytosis, G6PD, Pyruvate kinase, thalassemia)
Extravascular - swallowed blood, trauma (bruising)
- Polycythemia

INCREASED REABSORPTION
- Breast milk jaundice (incr Beta glucuronylase - pervents conversion of bili to direct - is recirculated)

REDUCED EXCRETION
Hepatic delivery/uptake:
- patent ductus venosus ‘shunt bilirubin from liver conjugation’
- Blockage of cytosol receptor protein (milk, drug)
- Glucuronyl transferase (Gilbert’s, familial)
- Enzyme inhibitor (Drug, Galactosemia)
Bilirubin Conjugation
- Transport defect (Dubin, Johnson, Rotor)
- Hepatocyte damage (A1AT, tyrosine/galactosemia)
- TPN
Bile Flow Obstruction
- Biliary atresia**
- CF
- Choledochal cyst
- Annular pancreas
- Tumor

MIXED
- Sepsis, hypothyroid, infections (TORCH, HIV, Hep B)

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12
Q

At what bilirubin level do you see jaundice?

A

85-120

It progresses in a cephalocaudal progression

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13
Q

What are the TORCH infections?

A

Vertically transmitted viruses, bacteria, infection

T – Toxoplasmosis / Toxoplasma gondii
O – Other (cocksakie, varicella, Parvovirus B19, Chylamdia, HIV, Syphilis)
R – Rubella
C – Cytomegalovirus
H – Herpes simplex virus-2 or neonatal herpes simplex

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14
Q

Treatment of pediatric jaundice in newborn

A

Supportive, feeding, Phototherapy (>150), Exchange transfusion for really high levels.

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16
Q

Which organisms are most likely to cause sepsis in newborn?

A

GBS
Ecoli
Listeria
Klebsiella

Late onset sepsis: Staph, Strep pneumo, Meiningococcus (neiserria meningitis) plus above

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16
Q

Peds: What is the ddx on acute onset hip pain in child?

A
  1. Trauma, NAT
  2. Legg calve perthes dz (AVN of femoral epiphysis)
  3. SCFE - slipped capital femoral epiphysis. (SH I type injury)
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17
Q

Peds: What is the Salter Harris classification for fractures?

A

I - through the physis - closed reduction and cast immobilzation.
II - (Above) - through physis and metaphysis
III - (Low) - through physis and Epiphysis
IV - (Through and through) - through both epiphysis and metaphysis
V - (Ram) - Crush injury - poor prognosis. growth arrest

there are up to salter harris 9. fun fact additional ogden criteria

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18
Q

What are 5 of 7 Risk factors for SIDS

A
  1. Young mothers, multiparious
  2. Sibling that died of SIDS
  3. Prone sleeping
  4. Smoking
  5. Premature/LBW infant
  6. Low SES
  7. During RSV season
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19
Q

Peds: Etiology for constipation (5)

A
  1. Functional 99%
  2. Obstruction (Hirshsprungs)
  3. Endocrine (Hypothyroid, DM, hyperCa)
  4. Neurogenic bowel (spina bifida)
  5. Anal Fissures, structure, stenosis
  6. Rx: lead, chemotx, opiods.
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20
Q

Peds: What is the formula to estimate the normal systolic BP in a child? (this is the 5th %ile)

A

BP = 70mmHg + age(2)

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21
Q

Peds: What are some clinical signs of respiratory distress?

A
  1. Grunting, wheeze, stridor
  2. Head bobbing
  3. Tracheal tug
  4. Intercostal indrawing
  5. Suprasternal indrawing
  6. Nasal flaring
  7. Tripoding
  8. Seasaw breathing
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23
Q

Peds: DDX stridor (8)

A
  1. FB aspiration
  2. Epiglottitis
  3. Tracheomalacia/Laryngomalacia
  4. Subglottic stenosis (congenital or anaphylaxis)
  5. Croup
  6. Bacterial tracheitis
  7. Retropharyngeal abcess
  8. Hereditary angioedema
  9. Laryngospasm
  10. Vocal cord dysfunction/paralysis (not acute)
  11. Laryngeal diphtheria
  12. Anaphylaxis
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23
Q

Peds: Name 4 common viruses that cause URTI in children

A
  1. RSV (winter - spring)
  2. Parainfluenza (fall - winter)
  3. Coxsakie virus :summer
  4. Influenza (Dec-jan)
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24
Q

Peds: DDX stridor (8)

A
  1. FB aspiration
  2. Epiglottitis
  3. Tracheomalacia/Laryngomalacia
  4. Subglottic stenosis (congenital or anaphylaxis)
  5. Croup
  6. Bacterial tracheitis
  7. Retropharyngeal abcess/paratonsillar abcess
  8. Hereditary angioedema
  9. Laryngospasm
  10. Vocal cord dysfunction/paralysis (not acute)
  11. Laryngeal diphtheria
  12. Anaphylaxis
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25
Q

What is the general treatment for croup?

A
  1. O2, supportive
  2. 0.6mg/kg Dexamethasone
  3. Racemic epinephrine
  4. Observe 4 hours - if not better = admit

Nebulize epinephrine
- Racemic epinephrine 2.25% (0.5 mL in 2.5 mL saline)
or
- L-epinephrine 1:1,000 (5ml)

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26
Q

What viruses cause croup?

A
  1. Parainfluenza (most common)
  2. RSV
  3. influenza A
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27
Q

What is the difference between epiglottis vs bacterial tracheitis (in terms of where it is effected anatomically)

A

Epiglottitis is suprglottic edema and bacterial tracheitis is subglottic edema

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28
Q

Peds: What bacteria cause epiglottis?

A
  1. Haemophilus influeza B
  2. gram negative cocci
  3. In adults (now more common) is polymicrobial
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29
Q

Peds: What bugs can cause bacterial tracheitis? (3)

A

Can be a complication of Croup

  1. Staph
  2. Strep
  3. Parainfluenza
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30
Q

What is Bronchiolitis? and what is the natural history (peak and duration of illness)

A

1st episode of wheezing with assc URTI and signs of respiratory distress. There is inflammation of the bronchioles.
- Peak day 4-5 and last ~8 days.

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32
Q

What virus is responsible for most of Bronchiolitis?

and what is one of the most feared complications?

A 
RSV (70-80%)
Human metapneumovirus (10-20%)
Adenovirus
Rhinovirus
Parainfluenza
Influenza

Apnea - premies more at risk.

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32
Q

Peds: In neonates, which are the most common bacteria that cause pneumonia?

A

GBS, Ecoli, Listeria

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34
Q

Peds: Bronchiolitis typical management

A
  1. Supportive, O2, IVs. Suction
  2. HS saline (only evidence to use during admission dec LOS)
  3. Ventolin (no support but may consider in moderate or severe)
  4. Ribavirin (only for high risk groups - Bronchopulmonary dysplasia, CHD, immune def)
  5. Steroids are not effective. nor are Abx - unless also has bacterial pneumonia

Admit if consistently tachypneic and hypoxic

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34
Q

Peds: What are the most common pneumonia causing bacteria in 1-3 month olds, and 3mo-5 years?

A
  1. Strep Pneumo
  2. Staph. aureus
  3. H. influenza
  4. Pertussis (1-3month olds)
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35
Q

Peds: What are the doses for Tylenol and Advil?

A
  1. Tylenol 15mg/kg - q 6 hours (concentration usu 80mg/mL)

2. Advil 10 mg/kg q 4 hours. (concentration usu. 40mg/mL)

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36
Q

Peds: what are the most common pneumonia causing bacteria in >5 y.os? (6) + 1 for immunocompromized.

A
  1. Strep pneumo
  2. Staph aureus
  3. Mycoplasma pneumonia (not gram + or-)
  4. Chlamydiophylia pneumonia
  5. Haemophilus influenza
  6. Klebsiella pneumoniae
  7. Legionella (immunocompromised)
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37
Q

Peds: What congenital heart dz is associated with each of these CXR findings?

  1. Boot shaped heart
  2. Egg shaped Heart
  3. Snow man heart
A
  1. Tetrology of Fallot or Tricuspid Atresia
  2. Transposition of Great arteries (TGA)
  3. TAPR - Total anomlaous pulmonary venous return

(all these CHD need endocarditis propylaxis prior to procedures)

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38
Q

Peds: What are the acyanotic Congenital heart Dx? (6)

A

AVAPCA-P

  1. L-R shunt
    - ASD - ostium secundum most common
    - VSD - most common. can lead to CHF if unTx.
    - AVSD
    - PDA - functional closure w/in 15 h of life. Anatomic closure w/in days. Tx: indomethacin
  2. Obstructive
    - Coarctation - assc with bicuspid Ao valve.
    - Ao Stenosis
    - Pulmonic Stenosis
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39
Q

Peds: What are the acyanotic Congenital heart Dx? (6)

A

AVAPCA-P

  1. L-R shunt
    - ASD - ostium secundum most common
    - VSD - most common. can lead to CHF if unTx.
    - AVSD
    - Patent ductus arteriosus (PDA) - functional closure w/in 15 h of life. Anatomic closure w/in days. Tx: indomethacin. PGE-1 to keep open
  2. Obstructive
    - Coarctation - assc with bicuspid Ao valve.
    - Ao Stenosis
    - Pulmonic Stenosis
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40
Q

What is the hyperoxic test?

A

Give 100% O2 10-15 min and test PaO2 (ABG from Rt. arm (pre-ductus)) - if there is improvement then the hypoxia is most likely a pulmonary cause.

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41
Q

Peds: What are the defects assc with tetrology of fallot? (4)

A
  1. VSD
  2. Pulmonic stenosis
  3. Overriding aorta
  4. RVH
  5. sometimes ASD
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42
Q

Peds: What are the cyanotic congenital heart lesions? (6)

A
  1. ToF
  2. Tricuspid Atresia
  3. Transposition of Great vessels
  4. Hypoplastic Lt heart syndrome
  5. Total anomalous pulm venous return
  6. Truncus arteriosus

5T’s (ToF, TGA, TA, TAPVR, __)

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43
Q

Peds: What are the cyanotic congenital heart lesions? (6)

A
  1. ToF
  2. Tricuspid Atresia/Truncus arteriosus
  3. Transposition of Great vessels
  4. Hypoplastic Lt heart syndrome
  5. Total anomalous pulm venous return

5T’s (ToF, TGA, TA2, TAPVR,)

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44
Q

Peds: What drug do you give to keep the ductus arteriousus open?

A
  1. Prostaglandin E1 (PGE1)
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45
Q

Peds: What are the features of an innocent murmur?

A
  1. Systolic
  2. Not > grade III
  3. No Regurgitation
  4. All have normal heart sounds
  5. No clicks or EHS present.
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46
Q

What 3 criteria are need to diagnose DKA?

A
  1. Hyperglycemia
  2. Ketones in urine or serum
  3. Wide AG acidosis
47
Q

What are some precipitants of DKA? (9)

A
  1. Infection
  2. Infarction (stroke, MI)
  3. Ischemia
  4. Intra-abdominal (appendicitis, cholecystitis, peritonitis, pancreatitis)
  5. Iatrogenic (steroids, insulin dose)
  6. Incision
  7. Intoxication (ETOH, or other drugs)
  8. Initial presentation
  9. Insulin - Non compliance
48
Q

DKA General management (at least 3)

A

1. Fluid resuscitation - aggressive

  1. Insulin 0.1U/kg/hour (this is to correct acidosis NOT hyperglycemia)
  2. Start giving D5W when glucose 11 - monitor K and Phosphate - will initially be hyperkalemic then hypokalemic
  3. If pH <6.9 some will consider adding NaHCO3
49
Q

In DKA - if urine dip is negative or serum is negative for ketones, is it still possible to have DKA?

A

Yes. the urine dip only recognises Acetoacetate but not B-hydroxybuterate (the 2nd type of ketone made) so you can run specific test for this.

50
Q

What is the general Tx for HHNS (hyperglycemic hyperosmolar non-ketotic synrome)?

A
  1. Aggressive Fluids

2. Low dose insulin.

51
Q

In DKA, why would you not give insulin right away? (hint K)

A

If the K is <3.3, then do not give insulin because it will cause hypokalemia and can precipitate an arrhythmia. So replace K first then give insulin.

52
Q

In DKA, what does the literature say about initial Bolus insulin?

A
  1. Studies show that initial bolus (0.1U/kg once) does not confer any benefit and may be assc with cerebral edema - but this may be due to fact that those pts were more severe)
  2. We have moved away from Bolus and just give infusion now.
53
Q

In Peds DKA - what is the current thinking in terms of fluid resuscitation.

A
  1. Fluid resuscitation - current literature is saying you don’t want to give more than 45cc/kg of fluid (bolus) in first 4 hours - may incr incidence of cerebral edema.
  2. Consider talking to pediatric endocrinologist.

Ultimately literature on this is sparse.

54
Q

DDX sick neonate

A

T-Trauma (nonaccidental and accidental)
H-Heart disease/hypovolemia/hypoxia
E-Endocrine (congenital adrenal hyperplasia, thyrotoxicosis)
M-Metabolic (electrolyte imbalance)
I-Inborn errors of metabolism: Metabolic emergencies
S-Sepsis (meningitis, pneumonia, urinary tract infection)
F-Formula mishaps (under- or overdilution)
I-Intestinal catastrophes (volvulus, malrotation, intussusception, necrotizing enterocolitis)
T-Toxins/poisons
S-Seizures

55
Q

Peds: When do you develop the several sinuses?

A
  1. You are born with ME (Maxillary and ethmoid)
  2. Sphenoid 5 years old
  3. Frontal sinuses develops around 7 years.
56
Q

Peds: Ddx scrotal pain and swelling

A
  1. Epididymitis
  2. Orchitis
  3. Testicular Torsion
57
Q

Peds: What is the ddx for Abdominal pain in kids? (14)

A
  1. Pyloric Stenosis
  2. Malrotation
  3. Mid gut volvulous (commonly rotates around SMA causing ischemia)
  4. Appendicitis
  5. Intusseception
  6. Duodenal Atresia
  7. Mesenteric adenitis
  8. Constipation
  9. Referred pain from pneumonia, UTI, Renal colic
    (RLL can mimic appy)
  10. Gastroenteritis
  11. PUD
  12. DKA
  13. Henoch-Schnlein purpura (arthritis, abdo pain and palpable purpura IgA mediated)
    14, Testicular Torsion (Check cremaster reflex)
58
Q

What are the organisms responsible for epididymitis or orchitis?

A

Gonorrhea/Chylmadia, Mumps (after parotitis)

59
Q

What is Phren’s sign?

A

Pain relief with elevation of testicle suggests epididymitis. Pain will not go away with torsion not Sn or Sp.. Doppler best.

60
Q

What are 2 diarrhea causing pathogens that cause symptoms in <8 hours?

A
  1. Staph aureus

2. B. cereus

61
Q
  1. What does testicular torsion present with?
  2. What 2 things can tort?
  3. What age range does this happen?
  4. How long do you have to fix before permanent damage?
  5. What is the ‘blue dot sign’?
A
  1. Acute onset scotal pain. will have negative phren’s sign and absent cremasteric reflex.
  2. Torsion of spermatic cord or testicular appendix.
  3. More common in teens
  4. Have 5-6 hours to re-tort or will loose testicle.
  5. Blue discoloration on testicle - indicative of torsion of appendix
62
Q

What are 10 diarrhea causing organisms?

A
  1. E. coli
  2. Salmonella
  3. Vibrio cholera
  4. Yersinia
  5. C. Diff
  6. Campylobacter
  7. EHEC - 0157:H7
  8. Shigella
  9. Giardia
  10. Entamoeba Histoytica
63
Q

Which Diarrhea causing organisms cause Bloody diarrhea? (4)

A
  1. Campylobactor
  2. EHEC 0157:H7
  3. Shigella
  4. E. Histolytica.
64
Q

Which diarrhea causing bacteria mimics appendicitis?

A

Yersinia

65
Q

What is travellers diarrhea caused by?

A

E coli. (Enteroinvasive EC-toxigenic)

66
Q

Which diarrhea causing bacteria is associated with HUS?

A

EHEC 0157H7

- get Hemolytic uremic syndrome (MAHA, renal failure, thrombcytopenia, hematuria)

67
Q

What is toddler’s diarrhea?

A

Diarrhea caused by excess juice ingestion. has high osmolarity so will cause water to be drawn into colon..

68
Q

Peds: What are the VACTERL associations?

A 
Vertebral dysgenesis
Anal atresia (imperforate)
Cardiac abN (common VSD)
Tracheal esophageal fistula
Esophageal atresia
Renal anomalies
Limb anomalies (polydacylyl)
69
Q

DDX for Microcytic Anemia? (5)

A
  1. Fe Def anemia
  2. Thalasemia
  3. Anemia of Chronic dz
  4. Lead poisoning
  5. Sideroblastic anemia
70
Q

DDX for Normocytic anemia?

A
  1. Anemia of Chronic disease
  2. Acute hemorrage/hemolytic anemaia
  3. Myelodysplasia
  4. Liver Disease
  5. Infilration (leukemia, mets, myeloma, infection)
  6. Uremia
  7. Hyperthyroid/Hypothyroid
71
Q

DDX for Macrocytic anemia

A
  1. B12 or Folate deficency
  2. ETOH
  3. Liver Disease
  4. Myelodysplasia
  5. Reticulocytosis
72
Q

What is the deficency that causes TTP (thrombotic thrombocytopenic purpura)?

A

Deficiency of ADAMS 12 metallo-protease.

Results in plt aggregation and thrombosis.

73
Q

Where is vWF made?

A

secreted by endothelial cells. It is secreted in a large polymer that is cleaved by ADAMS13 metallo-protease.

74
Q

What is the pentad associated with TTP?

A
  1. Thrombocytopenia
  2. Hemolysis
  3. Renal failure
  4. Neuro symptoms (HA, confusion, focal deficits)
  5. Fever

Tx: plasmaphoresis

75
Q

What is HUS caused by?

A
  • Shigella or EHEC toxin
  • Toxin binds and activates endothelial cells and platelets. leads to microvascular damage and plt aggregation in kidneys
76
Q

What is the HUS triad?

A
  1. MAHA
  2. Renal failure
  3. Thrombocytopenia
77
Q

DDX isolated incr PT/INR (5)

A
  1. Factor 7 def (inherited)
  2. Warfarin
  3. Vit K def
  4. Liver disease
  5. Factor 7 inhibitor
78
Q

DDX isolated PPT elevation (3)

A
  1. Hemophilias
  2. vWD
  3. Heparin
79
Q

DDX incr PT and PTT (4)

A
  1. Deficencies of prothrombin, fibrinogen, Factor V, X or combined factor def
  2. Heparin + warfarin
  3. DIC **
  4. Liver Dx
80
Q

What are the most common causes of OM in children? (3)

A
  1. Strep pneumo
  2. H influenza
  3. M. catarhalis

Tx: Amoxicillin

81
Q

What are some complications of Otitis Media (OM)?

A
  1. Mastoiditis
  2. Chronic suppurative otitis media
  3. Postauricular abscess
  4. Facial nerve paresis
  5. Labyrinthitis
  6. Labyrinthine fistula
  7. Temporal abscess
  8. Petrositis
  9. Intracranial abscess
  10. Meningitis
  11. Sigmoid sinus thrombosis
  12. Encephalocele
82
Q

What is the ‘typical hx/features’ of scarlet fever?

A
  1. Acute onset fever + sore throat
  2. Strawberry tongue
  3. Sandpaper Rash followed by peeling
83
Q

For Rheumatic fever - what is the jones criteria?

A
  1. Evidence of strep infection
  2. 2 major criteria OR
    1 major and 2 minor criteria
84
Q

For Rheumatic Fever: What are the major criteria? (5)

A

SPACE
1. Subcutaneous nodules - pea size, non tender
2. Pancarditis
3, Arthritis
4. Chorea
5. Erythemia marginatum (pink macules on trunk)

85
Q

For Rhuematic fever: What are the minor criteria?

A 
CAFEPAL
CRP elevated
Arthralgias
Fever
ESR elevated
PR interval incr. 
Anamnesis of rheumatism (hx of rheumatic heart dx or inactive heart disease)
Leukocytosis
86
Q

What are the organisms that cause UTI’s?

A 
KEEPS
Klebseilla
Enterococcus
E.coli
Proteus/pseudomonas
Staphylococcus saphriticus
87
Q

What syndrome can kids get if they take aspirin during URTI (particularly varicella or influnza)?

A

Reye’s Syndrome

40% mortality!

88
Q

Measles: What is the prodrome + characteristics? (4)

A
  1. 3 C’s: Cough, coryza, Conjunctivitis
  2. Koplik spots (white spots on buccal mucosa)
  3. Abrupt high fever 40-40.5
  4. Rash: Starts on face and descends. Maculopapular to confluent.
89
Q

What are complications of Measles?

A
  1. AOM
  2. Pneumonia - 1 in 20
  3. encephalitis - 1 in 1000
  4. DIC
90
Q

What Bug causes Baby measles (Roseola infantum)

A

HHV6 (human herpes virus 6)

91
Q

For Roseola infantum (baby measles), what are the main characteristics and Treatment (5 characteristics)

A
  1. 39.5
  2. Erythematous maculopapular rash
  3. Erythema tonsils and pharyx
  4. Lymphadenopathy

Tx: Acetaminophen

92
Q

When in chicken pox infective?

What medication do you avoid?

A

Pre-rash 1-2 days until all vesicles crusted.

Avoid Aspirin due to Reye’s syndrome! (40% mortality)

93
Q

What organism causes slapped cheek dz (erythema infectiosum)?

A

Parvovirus B 19,

aka. 5th disease.

94
Q

What are the 5 criteria needed to diagnose Kawasaki’s disease?

A

Fever >5 days usu >40deg Plus 4/5 of following:

  1. Mucus membrane changes (strawberry tongue, dry lips, erythematous mouth, pharynx)
  2. Bilat. non purulent conjunctivitis 94% have
  3. Rash: Polymorphous erythemayous Exanthem on trunk - anything except vesicles. 92% pts
  4. Adenopathy: UNILATERAL >1.5 cm lymph node
  5. Extremity changes: erythema palms/soles, Red swollen dequamating rash of palms and soles (presents late)

High dose Aspirin + IVIG

95
Q

Infants are obligate nose breathers until which age?

A

3-6 months.

96
Q

Whats the ddx for a generalized rash? (5)

A
  1. Viral illness
  2. Drug eruption
  3. Toxin mediated
  4. Immune mediated
  5. Others: Kawasaki’s

ultimately secondary to systemic exposures.

97
Q

What viruses cause hand foot and mouth disease?

A

Coxsackie A virus and Enterovirus.

98
Q

Whats the ddx for a Rash that involves the Palms and Soles of the feet? there are 12

A
  1. Hand foot and mouth disease
  2. Scabies
  3. SJS, EM (erythema multiforme)
  4. Syphilis (secondary and congenital)
  5. Atopic Dermatitis
  6. Kawaski’s syndrome
  7. Atypical measles
  8. Rocky mountain spotted fever
  9. Tinea Manuum
  10. Psoriasis
  11. Epidermolysis Bullosa
  12. Purpura fulminans
99
Q

DDX of Rash only on lower Extremities? (3)

A
  1. Meningococcal infection (neisseria meningitis)
  2. Henoch Scholein purpura
  3. Rocky mountain spotted fever
100
Q

DDX of Strawberry tongue? (3)

A
  1. Kawasakis
  2. Scarlet Fever
  3. Staphylococcal Toxic Shock syndrome
101
Q 
Chicken Pox (Varicella):
What is the incubation period?, when is it contagious?, How is it transmitted? and what are 4 major complications?
A
  1. incubation period: 10-21 days
  2. is infectious 2 days prior to onset of rash until all vesicles have crusted over
  3. Transmitted by droplet and airborne
  4. complication include: neonatal acquisition, GAS superinfection (50-80 fold higher in these pts), Pneumonia, CNS involvement and Reye’s syndrome with aspirin administration.
102
Q

What are some major organisms that are spread via airborne? (name at least 4 - there are 7)

A
  1. Varicella
  2. Measles.
  3. TB
  4. Influenza
  5. Pertussis
  6. Small Pox
  7. Anthrax
103
Q

What virus causes Roseola Infantum?
What is the characteristic history?

aka. Baby measles.

A
  1. Human Herpes Virus 6 (and 7)

2. In an infant, get high fever 3-7 days followed by a diffuse erythematous maculopapular rash

104
Q

What causes erythema infectiousum?
What is the characteristic history and rash?
What are 2 other names for this disease?

A
  1. Parvovirus B 19
  2. Prodrome fever, malaise 5-7 days, followed by erythematous, macularpapular coalesing rash - can be lace like. Also slapped cheek appearance.
    Rash starts on trunk
  3. Slapped cheek disease, 5th disease.

remember is one of the TORCH infections.

105
Q

What bacteria cause Impetigo?

A
  1. Staph aureus

2. Group A Beta hemolytic Strep

106
Q

Toxin mediated, Kolsy’s sign +, desquamation of entire skin in infants and toddlers, dehydration main concern, not mediated by staph or strep. What is the diagnosis?

A

Staphylococcal scalded Skin Syndrome (SSSS)

107
Q

What are the main complication of Kawasaki’s disease?

A
  1. Coronary a. aneurysms

Can also get: Myocarditis, Valvulitis, Pericardial effusion, systemic artery aneurysms

108
Q

Measles (red measles):
What virus is it caused by?
What is the characteristic history and rash?
What are 4 bad complications?

A
  1. Morbillivirus
  2. Prodrome: cough, coryza, conjunctivitis, fever, (may have koplik spots), then abrupt rise in fever then Maculopapular Rash starting on head then spreads to rest of body.
    can get lympadenopathy in the 2nd phase which may be assc with intussecption..
    May have hemorrhagic disease and mild liver involvement in adults
  3. Pneumonia, OM, and encephalitis, subacute sclerosing panencephalitis (fatal), DIC
109
Q

What are the most common causes of pediatric out of hospital cardiac arrest?

A
  1. SIDS- 23%
  2. Trauma - 20%
  3. Submersion injuries - 12%
110
Q

What are 10 differences of the pediatric airway?

A

1) Big tongue and more soft tissues (adenoids)
2) Narrowest point at subglottis - Narrowest part of the trachea is at the cricoid versus the vocal cords – Makes tube sizing more critical
3) Anterior/cephalad larynx - Higher and more anterior glottis opening – Makes the oral, pharyngeal and tracheal axis more difficult to align
4) Short trachea - Short trachea (5-6cm) – Can make tube dislodgement with head manipulation and accidental intubation of the right mainstem bronchus easier
5) Large occiput - puts pt in flexion. To get sniffing position= roll under shoulders
6) Big floppy epiglottis- use miller blade
7) Higher metabolic rate
8) Lower FRC - Makes a neonate desaturate faster once they have been paralyzed. Higher metabolic demands – Have a much higher cardiac output and therefore will utilize oxygen much faster
9) More compliant chest wall
10) Smaller airway caliber - need appropriate size of equipment

111
Q

What is Eisenmenger’s syndrome?

A

Process of L to R shunt turning into a R to L shunt.

- Can occur in congenital VSD, initially left side has higher pressures then there is RVH and the shunt revereses

112
Q

What are 7 side effects of PGE-1? - to keep open PDA (cyanotic heart dz)
In what condition is PGE-1 contraindicated?

A
  1. Apnea (consider intubating)
  2. Hypotension
  3. Bradycardia
  4. Cutaneous vasodilation (Flushing)
  5. Seizures
  6. Hyperthermia
  7. Renal Failure
  8. ICH/NEC (necrotizing enterocolitis)

Contraindicated in TAPVR (will make worse)

113
Q

AVSD is associated with what syndrome?

A

Down’s syndrome.

114
Q

What is considered a concerning level of conjugated bilirubin?

A

if the level is above 10 or 20% of the TSB

115
Q

Where in the esophagus is a FB more likely to get stuck?

A
  1. Thoracic inlet (between clavicles - anatomical change from skeletal m. to sm. m)
    - Cricopharyngeus sling at C6 is also at level of inlet. (70%)
  2. Mid esophagus (15%)
    - aortic arch and carina overlap- there is a natural narrowing.
  3. Lower esophageal sphincter (15%)

Emergency Medicine (39 decks)

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